Provider Demographics
NPI:1487067104
Name:PAINTER, CHRISTINA RENEE (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:RENEE
Last Name:PAINTER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 LESLIE PL
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-8901
Mailing Address - Country:US
Mailing Address - Phone:304-760-8260
Mailing Address - Fax:
Practice Address - Street 1:113 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25313-1467
Practice Address - Country:US
Practice Address - Phone:304-342-9515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP 0715235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist